Ebru Turkoglu

Unsynchronized nasal intermittent positive pressure versus nasal continuous positive airway pressure in preterm infants after extubation

Abstract Objective: To determine the effect of unsynchronized nasal intermittent positive pressure ventilation compared to continuous positive airway pressure in preterm infants after extubation. Methods: A total of 67 premature infants who were <35 weeks gestation and/or <2000 g birth weight and received mechanical ventilation because of respiratory distress syndrome (RDS) were studied. Infants were randomized to receive either unsynchronized nasal intermittent positive pressure ventilation (NIPPV) with shortened endotracheal tube (Group 1) or nasal continuous positive airway pressure (NCPAP) with binasal prongs (Group 2) after extubation. Extubation failure and neonatal outcomes were recorded in each group. Results: There were no significant differences in clinical characteristics between the two groups. The prevalence of re-intubation and post-extubation atelectasis were higher in CPAP group (p = 0.03 and p = 0.01). No differences were observed in the prevalence of IVH, ROP, PDA, NEC, sepsis, pneumothorax, BPD and BPD/death between the groups while the mortality was higher in NCPAP group (p < 0.01). Neither procedure had any serious side effects such as intestinal perforation. Conclusion: NIPPV (although non-synchronized and delivered by single nasal prong) had a better effect than NCPAP after extubation of preterm infants on mechanical ventilation in respect to reducing the prevalence of post-extubation atelectasis, re-intubation and also death.

Effects of synchronized intermittent mandatory ventilation versus pressure support plus volume guarantee ventilation in the weaning phase of preterm infants

Objective: To compare the effects and short-term outcomes of pressure support ventilation with volume guarantee versus synchronized intermittent mandatory ventilation in the weaning phase of very low–birth weight infants with respiratory distress syndrome. Design: Randomized controlled prospective study. Setting: Tertiary care neonatal unit. Patients: A total of 60 premature infants who were less than 33 weeks’ gestation and/or less than 1,500 g birth weight and received mechanical ventilation because of respiratory distress syndrome were studied. Interventions: All infants were ventilated from the time of admission with synchronized intermittent positive pressure ventilation mode after surfactant treatment for respiratory distress syndrome and then switched to pressure support ventilation with volume guarantee or synchronized intermittent mandatory ventilation mode in the weaning phase. The ventilatory variables and neonatal outcomes were recorded in each group. Measurements and Main Results: The mean peak inflation pressure was higher in synchronized intermittent mandatory ventilation group (p < 0.001) and the mean airway pressure was higher in pressure support ventilation with volume guarantee group (p = 0.03), whereas mean tidal volume and respiratory rates were similar in both groups. The prevalence of postextubation atelectasis was higher in synchronized intermittent mandatory ventilation group, but the difference was not statistically significant (p = 0.08). No differences were found in the prevalence of reintubation, patent ductus arteriosus, intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, and pneumothorax between the groups. Conclusions: Pressure support ventilation with volume guarantee mode may be a safe and feasible mode during the weaning phase of very low–birth weight infants on mechanical ventilation support for respiratory distress syndrome with respect to reducing the frequency of postextubation atelectasis and using less peak inflation pressure.

Homozygous mutation of CRLF-1 gene in a Turkish newborn with Crisponi syndrome.

Crisponi syndrome is a recently described rare autosomal recessive disorder. The main clinical features of the syndrome are neonatal onset of episodic contractions of the facial muscles with trismus and abundant salivation resembling a tetanic spasm. Herein, we report a case of 3-day-old male neonate presenting with trismus, abundant salivation, feeding difficulties, camptodactyly, and hyperthermia, which are consistent with the diagnostic criteria of Crisponi syndrome. The parents of the patient were consanguineous, supporting autosomal recessive inheritance. Molecular analysis revealed a homozygous mutation in cytokine receptor-like factor-1 gene in the patient.

Reference ranges for sonographic dimensions of the liver and spleen in preterm infants

BackgroundPreterm infants usually have multiple comorbidities that affect spleen and liver. Ultrasonographic measurement of organ sizes is an important and reliable parameter in evaluation of spleen and liver pathology in preterm newborns.ObjectiveThe purpose of this study was to determine reference values of ultrasonographic measurements of the liver and spleen in preterm newborns.Materials and methodsWe prospectively performed sonography on 498 preterm newborns in the first week of life. We measured spleen and liver dimensions and statistically analyzed relationships between the dimensions and gender, gestational age (based on mother’s last menstrual period), height and weight. Reference ranges of dimensions were defined.ResultsLongitudinal and anteroposterior dimensions of the liver and spleen were statistically significantly different between the boys and girls (P < 0.05) and showed high correlation with the gestational age, weight and height. Weight was the parameter best correlated with the dimensions.ConclusionNomograms from these data are useful for sonographic evaluation of the liver and spleen in preterm newborns.

Comparison of oral and intravenous fluid therapy in newborns with hypernatremic dehydration.

Abstract Objective: To evaluate the efficacy and complications of oral and intravenous fluid therapy in newborns with hypernatremic dehydration. Methods: A total of 75 term and near-term (>35 weeks) neonates with hypernatremic dehydration (Na ≥ 150 mmol/L) were included in this retrospective study. The patients were divided into two groups according to therapy approach for rehydration (breast milk-oral formula and intravenous fluid). The decline in sodium concentration (<0.5 mmol/L/h was regarded as safe drop) and complications were analyzed. Results: The mean gestational age, birth weight and age at admission were 38.9 ± 1.4(36–42) weeks, 3341 ± 504 (2500–4500) gram and 4.3 ± 2.6 (1–17) day, respectively. Fever (61.8%) and jaundice (39.4%) were the most common presenting signs. Forty-four (58.6%) of the infants were treated with breast milk and/or oral formula (group 1) and 31 (41.4%) of the infants were treated with IV fluid (group 2). In group 1 and group 2, respectively, mean % weight loss, 5 and 7.5; median serum sodium at admission, 153 and 152 mmol/L; median change in sodium at 12 hours, 7 and 11 mmol/L; and median change in sodium at 24 hours, 10 and 15 mmol/L. The decline in sodium concentration was more safely in group 1 than group 2 at both 12 and 24 hours of rehydration. One patient had convulsion associated with cerebral edema in group 2. Otherwise no complication was observed in both groups. Conclusion: Enteral route for fluid replacement may be safe and effective and may be an alternative to intravenous fluid therapy in newborns with hypernatremic dehydration when clinical situation is stable.

Escherichia coli brain abscess in a twin pair associated with TLR4 gene mutation

Brain abscesses are uncommon complications of bacterial meningitis or sepsis in neonates and infants. The causative pathogens of brain abscess in newborns are various. Of those, Escherichia coli is rarely seen as a pathogen in brain abscess at this age. Herein we reported brain abscesses in twin infants caused by E. coli sepsis. Interestingly, genetic analysis identified heterozygous Toll‐like receptor 4 (TLR4) gene mutation in the twins. Because TLR plays an important role in the natural response to bacterial products and initiates specific immune response against these pathogens, this may explain the development of brain abscess in the present case.

An Unusual Case of Trisomy 18 Associated with Paucity of Bile Ducts

A case of neonatal cholestasis associated with Trisomy 18 (Edwards syndrome) is presented. A 3-day-old boy was referred to our clinic due to respiratory distress, elevated serum direct bilirubin levels, a systolic heart murmur, growth restriction and micrognathia. Liver biopsy and chromosomal analysis revealed paucity of intrahepatic bile ducts and Trisomy 18. Extrahepatic biliary atresia was reported in only a few patients with Trisomy 18. To our knowledge, we described for the first time a patient with Trisomy 18 and neonatal cholestasis associated with paucity of interlobular bile ducts.

Amniotic band sequence: An extreme case

Amniotic band sequence (ABS) is a rare cause of fetal disruptions associated with fibrous bands that entrap various fetal parts in utero and lead to abnormalities. Fetal disruptions of ABS are influenced by the timing of the amnion rupture and the site of amnion adherence. Herein we report an extreme case of ABS presented with dysmorphic face, amputation of four extremities and fusion of legs and genitalia with a fibrotic band. This is an extreme case of ABS characterized by an unusual combination of multiple fetal anomalies.

Homocysteine levels and its association with intraventricular hemorrhage in preterm infants born to preeclamptic mothers

Abstract Objective: To investigate the relation between serum homocysteine levels and intraventricular hemorrhage (IVH) in preterm infants born to preeclamptic mothers. Method: This study included 84 preterm infants (42 born to preeclamptic mothers and 42 born to normotensive healthy mothers) who were admitted to Izmir Tepecik Training and Research Hospital Neonatology Clinic on the postnatal first day. The measurement of homocysteine levels in all samples were performed with an Immulite 2000 analyzer, using the chemiluminescence method. Cranial ultrasounds were performed on the fourth day and in the 1 month of age. Results: The mean plasma levels of homocysteine in infants born to preeclamptic mothers and in the control group were 8.2 ± 5.9 μmol/L and 5.3 ± 2.7 μmol/L, respectively. The plasma levels of homocysteine were significantly higher in the study group (p = 0.006). There was no association between the plasma homocysteine levels and IVH or other neonatal complications including necrotizing enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia and mortality. Conclusion: Our data suggest that plasma levels of homocysteine are higher among infants born to preeclamptic mothers, but these high levels are not associated with IVH and other neonatal complications in preterm infants.

Neuronal apoptosis in the neonates born to preeclamptic mothers.

Abstract Objective: Preeclampsia may result in uteroplacental insufficiency and chronic intrauterine fetal distress. The aim of this study is to address this issue investigating neuronal apoptosis in an experimental model of preeclampsia and to evaluate the neurological outcome of the perinatal asphyxia in the neonates born to preeclamptic mother. Materials and methods: Two out of four pregnant Sprague–Dawley rats (preeclamptic group) were given water containing 1.8% NaCl on gestation day 15 and 22 in order to establish the model of preeclampsia whereas other two (non-preeclamptic group) received normal diet. A model of perinatal asphyxia was established on the postnatal 7th day to one preeclamptic and one non-preeclamptic dam. Overall 23 pups born to overall four dams were decapitated to assess neuronal apoptosis by the TUNEL assay. Results: The number of apoptotic neuronal cells was significantly higher in the preeclampsia groups in comparison with the control group (p = 0.006 and p = 0.006, respectively). It was also significantly higher in the asphyctic/non-preeclamptic group than the count in the control group (p = 0.01). There was also significant difference between both asphyctic groups (p = 0.003). Conclusion: We conclude that preeclampsia causes small babies for the gestational age and cerebral hypoplasia. Both preeclampsia and perinatal asphyxia can cause increased neuronal apoptosis in the neonatal brains. However, the prognosis for neurological outcome is much worse when the perinatal asphyxia occurs in newborns born to preeclamptic mothers.